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General NPI Number Information
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NPI Number | 1417219619
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Entity Type | Organization
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Legal Business Name | VIRTUA MEDICAL GROUP, PA
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Dates
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Enumeration Date | 06/13/2012
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 100 CENTURY PKWY STE 350
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-1149
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Country | US
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Telephone | 856-482-9000
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Fax | 856-482-1159
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Provider Business Mailing Address
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Address Line | 301 LIPPINCOTT DR STE 410
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City | MARLTON
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State | NJ
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Zip | 08053-4197
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Country | US
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Telephone | 856-355-0340
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Fax | 856-355-0330
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Authorized Official
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Title or Position | EVP; CHIEF OPERATING OFFICER
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Name | JOHN MARK MATSINGER
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Credential | DO
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Telephone | 856-355-0340
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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